Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

Table 1 Studies involving laparoscopic colorectal procedures with left-sided anastomosis

Author	Year	No. of patients	Overall leak rate (n)	Risk factor identified
Ito et al[8]	2008	180	5.0% (9)	TME
				N° of staplers firing (≥ 3)
Kim et al[36]	2008	266	6.4% (17)	Male sex
Pugliese et al[66]	2008	157	10.8% (17)	Conversion
Kim et al[47]	2009	270	6.3% (17)	Tumor location in middle or lower rectum
Zhu et al[40]	2010	132	9.1% (12)	Tumor size (diameter ≥ 3 cm)
				Distance from the anal verge (≤ 6 cm)
				TNM stage
Choi et al[45]	2010	156	10.3% (16)	Anastomotic level ≤ 5 cm from the anal verge
				Long operation time (≥ 270 min)
Huh et al[46]	2010	223	8.5% (19)	Extraperitoneal location of tumor
				Operative time > 220 min
Kayano et al[41]	2011	250	10.0% (25)	Male sex
				Multiple stapler firings (≥ 2)
Akiyoshi et al[49]	2011	363	3.6% (13)	Middle/low rectal cancer
				Lack of pelvic drain
Yamamoto et al[39]	2012	111	5.4 (6)	BMI
Hinoi et al[68]	2013	888	9.3% (83)	LCA ligation in LAR
Park et al[34]	2013	1609	6.3% (101)	Male sex
				Low anastomosis (< 7 cm)
				Preoperative chemoradiation
				Advanced tumor stage
				Perioperative bleeding (≥ 2 transfusions)
				Multiple firings of the linear stapler (> 3)
Kawada et al[42]	2014	154	12.3% (19)	Tumor size > 5 cm
				Operative time > 300 min
				Intraoperative bleeding > 100 mL
				Stapler firings > 3
				Precompression before stapler firing
Majbar et al[65]	2016	131	16.0% (21)	Conversion to open surgery
Silva-Velazco et al[38]	2016	1059	9% (95)	BMI ≥ 35 kg/m2
				N° of staplers firing
				Longer operative time
Van Praagh et al[74]	2016	16	50% (8)	Low diversity of gut microbiota
				High presence of Lachnospiraceae
Hamabe et al[35]	2017	296	8.1% (24)	Male sex
				Distance from anal verge < 7 cm
				Neoadjuvant chemotherapy
Lee et al[48]	2017	128	0.78% (1)	Stapler firings > 2
				Distance from anal verge
Tanaka et al[37]	2017	395	8.4% (33)	Male sex
				Absence of transanal tube
Ito et al[44]	2017	69	15.9% (11)	Absence of transanal tube
				Post-operative diarrhea
Shimura et al[43]	2018	196	5.61% (11)	Post-operative hypoalbuminemia
Van Praagh et al[75]	2018	123	23.6% (29)	Bacteroidaceae
				Low diversity of gut microbiota
				High presence of Lachnospiraceae
				Anostomosis covered with C-Seal

BMI: Body mass index; LCA: Left colic artery; LAR: Laparoscopic anterior resection; TME: Total mesorectal excision.

Table 2 Studies involving both right and left-sided anastomoses

Author	Year	No. of patients	Overall leak rate (n)	Risk factor identified
Kockerling et al[82]	1999	894	4.2% (38)	Rectal resection
				Malignant disease
				Anastomotic level < 10 cm from the anal verge
Senagore et al[80]	2003	260	2.7% (7)	BMI ≥ 30 kg/m2
Kirchhoff et al[83]	2008	1316	27.7% (59)	BMI ≥ 30 kg/m2
				Male gender
				Malignant neoplasia
Akiyoshi et al[79]	2011	1194	1.0% (12)	BMI ≥ 30 kg/m2
				Rectal tumor location
Ris et al[90]	2018	504	2.4% (12)	No use of indocyanine green

BMI: Body mass index.